The thoracic and lumbar spine fractures were usually combined with neurological deficit. But the prognostic factors in degree of neurological damage and process of the recovery are controversial. The purpose of this study is to evaluate the factors affected neurological injury and the recovery. The 31 cases who had been performed surgical interventions due to traumatic thoracic or lumbar spine fractures with the neurological deficits were studied according to the radiographic findings of the spinal columns and neurological changes of the injured cord and/or the roots. The duration of mean follow-up was 32.6 months, and all cases were evaluated by motor index score and Frankel grade. Total cases were divided into complete paralytic (N=8) and partial paralytic(N=23) group. In incomplete paraplegia group, the neurological recovery rate was better than complete group(P < 0.001) and neurological recovery period was shorter than complete group (P=0.005). The neurologic deficits according to the Frankel grade were higher in Chance fracture, flexion-distraction and translation (complete paraplegia: 4/7 cases, 57.1%) than unstable bursting fracture (complete paraplegia: 4/24 cases, 16.7%)(P=0.031). The recovery rate of Chance fracture, flexion-distraction and translation were worse than unstable bursting fracture (0.001). The fracture which occurred in T5-11 showed higher incidence of complete paraplegia(75%) compared with that of the T12-L1(30.8%) & L2-4(7.1%)(p=0.021). The neurological recovery in motor index score in L2-4 was higher than T5-11 or T12-L1(P=0.0017). There was no correlation in kyphotic deformity and anterior body height loss between complete and incomplete paraplegia groups. But the A-P diameter of compromised neural canal showed significant difference between complete and incomplete paraplegia group(P=0.027)
Body Height ; Congenital Abnormalities ; Follow-Up Studies ; Incidence ; Neural Tube ; Neurologic Manifestations ; Paraplegia ; Spine

We analyzed 77 patients with lumbosacral radiculopathy on the basis of electromyography and radiologic study including CT scan and myelography. The results were as followings: 1. In the 62 male and 15 female subjects with a mean age of 39.3 years. The peak incidence was between ages 20 and 40 years (64%). 2. The causes of lumbosacral radiculopathy were herniated lumbosacral intervertebral disc (78%), lumbar strain (9%), fracture of lumbar vertebra (6%), spinal cord tumor (4%), spinal stenosis(3%) in order. 3. Most common involving site was L5 root on EMG and L4-5 intervertabral disc space on radiological study. 4. The prognosis of the patients with normal EMG finding was better than that of the patients with abnormal EMG finding(p<0.05). 5. There was no significant difference between the prognosis of the patients with abnormal radiologic finding and that of the patients with normal radiologic finding.
Electromyography ; Female ; Humans ; Incidence ; Intervertebral Disc ; Male ; Myelography ; Prognosis* ; Radiculopathy* ; Spinal Cord Neoplasms ; Spine ; Tomography, X-Ray Computed

BACKGROUND: Cancer pain impacts the patient and improved pain management increases the quality of life (QOL) for the patient and entire family. One tablet of Ultracet(R) is composed of 37.5 mg of tramadol hydrochloride and 325 mg acetaminophen. Mechanism of action of Ultracet(R) is multiple blocking to pain transmission with 3 synergistic actions. Ultracet(R) shows high performance analgesic efficacy with good tolerability and fast onset in previous studies. METHODS: From February 2003 to January 2004, we treated 97 patients who had cancer pain. Brief pain inventory, WHO QOL-BREF, and EORTC QLQ-C30 were evaluated before, and after median duration of treatment of 17.9 days with Ultracet(R). RESULTS: Among 97 patients, male was 59 (61%) and female was 38 (39%). Mean age was 60.3+/-12.0 (range: 25-81 years). Stomach cancer was in 19, lung cancer in 14, lymphoma in 11, unknown primary carcinoma in 8, colorectal cancer in 7, in order of frequency. Pre/post treatment visual analogue scale (VAS) score was 6.43/4.46 (p=0.000). Mild pain in 11 patients and pre/post treatment VAS score of 2.09/1.91 (p=0.875), moderate pain in 33 and 5.21/3.64 (p=0.000), and severe pain in 53 and 8.09/5.51 (p=0.000). Change of QOL after pain management was significant in emotion (65.9/72.1, p=0.012) in functional scales, and pain in symptom scales (62.0/50.9, p=0.000), sleep disturbance (p=0.018), and constipation (p=0.038) in symptom scales. We compared a QOL scales of 3 groups by response to Ultracet(R); improvement (67), no change (17), and aggravation (13). Global health (p=0.000). fatigue (p=0.019), and sleep disturbance (p=0.003) were statistically different among 3 groups. CONCLUSION: Ultracet(R) is effective in moderate to severe cancer pain and contribute an improvement of quality of life (QOL) of cancer patients.
Acetaminophen ; Analgesics ; Colorectal Neoplasms ; Constipation ; Fatigue ; Female ; Humans ; Lung Neoplasms ; Lymphoma ; Male ; Pain Management ; Quality of Life* ; Stomach Neoplasms ; Tramadol ; Weights and Measures

Background/Aims: Integrated relaxation pressure (IRP) is a critical diagnostic criterion to define achalasia. However, there are some cases with typical symptoms and signs of achalasia but with normal IRP. The aim of this study is to evaluate the clinical characteristics of patients with achalasia with normal IRP and outcomes after peroral endoscopic myotomy (POEM). Methods: Patients with achalasia were collected in whom POEM was performed from November 2014 to April 2018 at CHA Bundang Medical Center. Achalasia with normal IRP was defined by findings compatible to achalasia in Eckardt score, endoscopy with endoscopic ultrasound, high-resolution manometry, impedance planimetry (EndoFlip), and timed esophagogram. Results: POEM was performed in 89 patients with achalasia; among them, 24 (27%) patients were diagnosed with achalasia with normal IRP. Patients with achalasia with normal IRP were older, had longer duration of symptom, and had a more tortuous esophagus. In EndoFlip, the distensibility index and cross-sectional area were higher in patients with normal IRP. Therapeutic outcomes showed no statistically significant differences. On correlation analysis, IRP had negative correlations with age, disease duration, and distensibility index. Conclusions Patients with achalasia of normal IRP value were older and had longer disease duration and higher distensibility index and crosssectional area than patients with achalasia with abnormal relaxation of lower esophageal sphincter. Therapeutic outcomes were not different between the 2 groups.

PURPOSE: To improve survival and/or to avoid radiotherapy, high dose chemotherapy (HDCT) with autologous peripheral blood stem cell transplantation (PBSCT) was given to patients with recurrent or high risk medulloblastoma (MB)/primitive neuroectodermal tumor (PNET) as well as patients younger than 3 years of age. METHODS: Six patients (3 recurrent, 1 high risk, 2 younger than 3 years; 5 MBs and 1 PNET) received single or double HDCT and PBSCT with or without immunotherapy using interleukin-2. Chemotherapeutic regimen in the first HDCT included cyclophosphamide (1,500 mg/m2/ day for 4 days) and melphalan (60 mg/m2/day for 3 days). Chemotherapeutic regimen in the second HDCT included carboplatin (400 mg/m2/day for 3 days), thiotepa (250 mg/ m2/day for 3 days), and etoposide (200 mg/m2/day for 3 days). RESULTS: Nine HDCTs were applied in 6 patients. Three double HDCTs were rescued with peripheral blood stem cells collected during single round leukapheresis. Rapid hematologic recovery occurred in 4 patients. Engraft failure occurred in 1 patient and delayed granulocyte recovery and platelet engraft failure occurred in 1 patient. Three patients who had minimal disease before HDCT had event free survival for 7~18 months after HDCT. Tumor relapsed 8 and 12 months after single HDCT in 2 patients among 3 patients with recurrent MB/PNET. One patient with recurrent MB died due to engraft failure and sepsis. CONCLUSION: HDCT with autologous PBSCT is expected to improve survival of patients with poor prognosis MB/PNET including younger patients less than 3 years. Subsequent trials with larger number of patients and long-term follow-up are needed.
Blood Platelets ; Carboplatin ; Cyclophosphamide ; Disease-Free Survival ; Drug Therapy* ; Etoposide ; Follow-Up Studies ; Granulocytes ; Humans ; Immunotherapy ; Interleukin-2 ; Leukapheresis ; Medulloblastoma ; Melphalan ; Neural Plate* ; Neuroectodermal Tumors* ; Neuroectodermal Tumors, Primitive ; Peripheral Blood Stem Cell Transplantation* ; Prognosis ; Radiotherapy ; Sepsis ; Stem Cells ; Thiotepa

No abstract available.
Arrhythmias, Cardiac* ; Humans ; Mitral Valve*

To determine the impact of treatment protocols on the outcome of central nervous system germ cell tumors (CNS-GCTs), we reviewed the medical records of 53 patients who received front-line chemotherapy from September 1997 to September 2006. Pure germinoma, normal alpha-fetoprotein level and beta-human chorionic gonadotropin level <50 mIU/mL were regarded as low-risk features and the others as high-risk. Patients from different time periods were divided into 3 groups according to the chemotherapy protocols. Group 1 (n=19) received 4 cycles of chemotherapy comprising cisplatin, etoposide and bleomycin. Group 2 (n=16) and group 3 (n=18) received 4 cycles of chemotherapy with cisplatin, etoposide, cyclophosphamide and vincristine in the former and with carboplatin, etoposide, cyclophosphamide and bleomycin in the latter. In group 2 and group 3, high-risk patients received double doses of cisplatin, carboplatin and cyclophosphamide. Radiotherapy was given after chemotherapy according to the clinical requirements. The event-free survivals of groups 1, 2, and 3 were 67.0%, 93.8%, and 100%, respectively (group 1 vs. 2, P=0.06; group 2 vs. 3, P=0.29; group 1 vs. 3, P=0.02). Our data suggest that risk-adapted intensive chemotherapy may improve the outcome of patients with malignant CNS-GCTs.
Adolescent ; Antineoplastic Agents/*therapeutic use ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Central Nervous System Neoplasms/pathology/*therapy ; Child ; Combined Modality Therapy ; Disease-Free Survival ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Neoplasms, Germ Cell and Embryonal/pathology/*therapy ; *Radiotherapy ; Risk Factors ; Treatment Outcome ; Tumor Markers, Biological/metabolism ; Young Adult

Neurofibromatosis type 1 (NF1) is a genetic disease characterized by neoplastic and non-neoplastic disorders involving tissues of neuroectodermal and mesenchymal origin. NF1 is caused by mutations in the NF1 gene, which is found on chromosome 17q11.2. Patients with NF1 are at increased risk of developing soft tissue sarcomas that arise within the stromal compartment of the gastrointestinal tract, termed gastrointestinal stromal tumors (GISTs). GISTs associated with neurofibromatosis differ from sporadic GISTs, particularly with respect to their lower response rate to imatinib. We recently experienced a case involving a 45-year-old man with NF1 who was admitted to the hospital with epigastric pain and vomiting. Abdominal computed tomography revealed a duodenal GIST with pancreatic invasion. He had a base substitution mutation involving replacement of 2041 cytosine with thymine. He was treated successfully with a surgical operation and adjuvant imatinib therapy.
Benzamides ; Cytosine ; Gastrointestinal Stromal Tumors* ; Gastrointestinal Tract ; Genes, Neurofibromatosis 1 ; Humans ; Middle Aged ; Neural Plate ; Neurofibromatoses* ; Neurofibromatosis 1* ; Piperazines ; Pyrimidines ; Sarcoma ; Thymine ; Vomiting ; Imatinib Mesylate

Neurofibromatosis type 1 (NF1) is a genetic disease characterized by neoplastic and non-neoplastic disorders involving tissues of neuroectodermal and mesenchymal origin. NF1 is caused by mutations in the NF1 gene, which is found on chromosome 17q11.2. Patients with NF1 are at increased risk of developing soft tissue sarcomas that arise within the stromal compartment of the gastrointestinal tract, termed gastrointestinal stromal tumors (GISTs). GISTs associated with neurofibromatosis differ from sporadic GISTs, particularly with respect to their lower response rate to imatinib. We recently experienced a case involving a 45-year-old man with NF1 who was admitted to the hospital with epigastric pain and vomiting. Abdominal computed tomography revealed a duodenal GIST with pancreatic invasion. He had a base substitution mutation involving replacement of 2041 cytosine with thymine. He was treated successfully with a surgical operation and adjuvant imatinib therapy.
Benzamides ; Cytosine ; Gastrointestinal Stromal Tumors* ; Gastrointestinal Tract ; Genes, Neurofibromatosis 1 ; Humans ; Middle Aged ; Neural Plate ; Neurofibromatoses* ; Neurofibromatosis 1* ; Piperazines ; Pyrimidines ; Sarcoma ; Thymine ; Vomiting ; Imatinib Mesylate

PURPOSE: We conducted a multi-center, phase II trial to evaluate the efficacy and safety of using Padexol (a paclitaxel formulation) combined with cisplatin for the patients suffering with advanced gastric adenocarcinoma. MATERIALS AND METHODS: 39 patients (median age: 60 years; males: 90%) who were diagnosed with advanced gastric cancer were enrolled from 5 hospitals. Padexol 175 mg/m2 was administered as a 3-hr infusion, and this was followed by cisplatin 75 mg/m2 as an intravenous infusion on day 1, once every 3 weeks. RESULTS: Out of these 39 patients, 34 patients were assessable for treatment efficacy and 39 patients were assessable for the toxicity. Objective responses occurred in 13 patients (33%); 1 patient (3%) had a complete response and 12 patients (31%) had partial responses. 6 patients (15%) achieved a stable disease state. The median duration of response was 7.1 months, and the median time to progression and the overall survival were 4.8 months and 6.7 months, respectively. The major treatment-related adverse events were hematologic toxicity, including WHO grade 3 or 4 neutropenia in 13 patients (33%). However, febrile neutropenia occurred in only 1 patient and the non-hematologic toxicity was usually mild. CONCLUSION: The combination of Padexol and cisplatin was found to be active and it seems to be a relatively well-tolerated regimen for the treatment of advanced gastric cancer.
Adenocarcinoma ; Cisplatin* ; Febrile Neutropenia ; Humans ; Infusions, Intravenous ; Male ; Neutropenia ; Paclitaxel ; Stomach Neoplasms* ; Treatment Outcome